Healthcare Provider Details

I. General information

NPI: 1225196108
Provider Name (Legal Business Name): JO ANN MCCORMICK M.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14045 N 7TH ST STE 4
PHOENIX AZ
85022-4387
US

IV. Provider business mailing address

5407 E KELTON LN
SCOTTSDALE AZ
85254-1109
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-4595
  • Fax:
Mailing address:
  • Phone: 602-788-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-140
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: